Which Lynch syndrome screening programs could be implemented in the "real world"? A systematic review of economic evaluations

Purpose: Lynch syndrome (LS) screening can significantly reduce cancer morbidity and mortality in mutation carriers. Our aim was to identify cost-effective LS screening programs that can be implemented in the "real world."Methods: We performed a systematic review of full economic evaluations of genetic screening for LS in different target populations; health outcomes were estimated in life-years gained or quality-adjusted life-years.Results: Overall, 20 studies were included in the systematic review. Based on the study populations, we identified six categories of LS screening program: colorectal cancer (CRC)-based, endometrial cancer-based, general population-based, LS family registry-based, cascade testing-based, and genetics clinic-based screening programs. We performed an in-depth analysis of CRC-based LS programs, classifying them into three additional subcategories: universal, age-targeted, and selective. In five studies, universal programs based on immunohistochemistry, either alone or in combination with the BRAF test, were cost-effective compared with no screening, while in two studies age-targeted programs with a cutoff of 70 years were cost-effective when compared with age-targeted programs with lower age thresholds. Conclusion: Universal or <70 years-age-targeted CRC-based LS screening programs are cost-effective and should be implemented in the "real world

The contribution of "spontaneous" health care networks to improving outcomes: Opportunities and challenges from the perspective of planning and control systems

The article aims to explore how Planning Control systems may support network-oriented policy-making in the health care sector. This work examines the case of ISMETT (Mediterranean Institute for high specialized transplants and therapies), a Sicilian hospital established in 1998 to provide high specialized and complex transplants and therapies. ISMETT pertains to several networks and it has a long-time experience in establishing and governing such inter-organizational relationships. The analysis of the case illustrates how health care networks may contribute to improve health and generate social and economic outcomes for the community

Multifractal analysis of the galaxy distribution: reliability of results from finite data sets

Submitted to Phys. Rev. ASIGLEITItal

Patterns of biodiversity in the northwestern Italian Alps: a multi-taxa approach

The current loss of biodiversity requires long-term monitoring of the distribution of living organisms, particularly in regions, such as mountains, which are highly sensitive to climatic and environmental changes. In 2007, three alpine parks in N-W Italy started a field program to determine the factors which influence animal biodiversity and identify the most appropriate methods for periodically repeatable monitoring. Twelve altitudinal transects (from montane to alpine belt) were chosen, each composed of 4-7 sampling units, for a total of 69 monitored plots. In each station, five taxonomic groups (carabids, butterflies, spiders, staphylinids, birds) were systematically sampled and topographic, environmental and micro-climatic variables were recorded. The aim was to assess the distribution of different taxa along altitudinal gradients and the relative influence of geographical, environmental and climatic factors. The data showed that species richness and community composition of invertebrates are mainly determined by altitude and microclimatic conditions, whereas birds are more sensitive to habitat structure. For invertebrates, the strong relationship with temperature suggests their potential sensitivity to climatic variations. The analysis of biodiversity patterns across vegetation belts indicated that the alpine belt hosts few species but a high percentage of endemic and vulnerable species, highlighting its importance for conservation purposes. This work offers a representative sample of the northwestern Italian Alps and it is a first step of a monitoring effort that will be repeated every five years to highlight the response of alpine biodiversity to climate and land-use changes

Ecological dynamics of two remote alpine lakes during ice-free season

We studied hydrochemistry and plankton dynamics in two remote alpine lakes: lake Nivolet <em>superiore</em> (2530 m asl) and lake Trebecchi <em>superiore</em> (2729 m asl) in the Gran Paradiso National Park (Western Italian Alps) in summer 2009. The aim of this study was to enhance the understanding of natural ecological dynamics in the pelagic habitat of alpine lakes by enlarging the number of biotic and abiotic variables usually considered to this end and by increasing the frequency of samplings, generally low in remote lakes. During the eight samplings performed in 2009, chemical and physical variables were measured both in situ and in the laboratory. We also followed the dynamics of all the compartments of the naturally simplified trophic chain of the two lakes from pico-prokaryotes to phytoplankton and zooplankton. Our results confirm the oligotrophic, close-to-pristine state of lake Nivolet and lake Trebecchi as they are not affected by hydromorphological alterations, they are naturally fishless and are not sensitive to acidification risk and acidity pulses. On the other hand, the two lakes have distinct abiotic conditions due to their glacial origin and to the lithological composition of their watersheds. We found some differences in the spatial variation of pico-prokaryotes, phytoplankton and zooplankton due to the different mixing regimes and maximum depth of the two lakes. Conversely, temporal patterns were similar in both lakes, related to ecological interactions and to changes in the abiotic conditions. The rapid succession of events in extreme ecosystems, such as the alpine lakes studied here, confirm the predominant role of external environmental factors (<em>e.g.</em> the duration of the ice-free season) and of ecological interactions among different trophic compartments. This research underlines the importance of seasonal niche partitioning among organisms with different size

Climate bistability of Earth-like exoplanets

Before about 500 million years ago, most probably our planet experienced temporary snowball conditions, with continental and sea ices covering a large fraction of its surface. This points to a potential bistability of Earth's climate that can have at least two different (statistical) equilibrium states for the same external forcing (i.e. solar radiation). Here, we explore the probability of finding bistable climates in Earth-like exoplanets and consider the properties of planetary climates obtained by varying the semimajor orbital axis (thus, received stellar radiation), eccentricity and obliquity, and atmospheric pressure. To this goal, we use the Earth-like planet surface temperature model (ESTM), an extension of one-dimensional Energy Balance Models developed to provide a numerically efficient climate estimator for parameter sensitivity studies and long climatic simulations. After verifying that the ESTM is able to reproduce Earth climate bistability, we identify the range of parameter space where climate bistability is detected. An intriguing result of this work is that the planetary conditions that support climate bistability are remarkably similar to those required for the sustenance of complex, multicellular life on the planetary surface. The interpretation of this result deserves further investigation, given its relevance for the potential distribution of life in exoplanetary systems